Provider Demographics
NPI:1396050977
Name:BARDGETT, STEPHANIE A (MPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:BARDGETT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ARNOLD MALL
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-2223
Mailing Address - Country:US
Mailing Address - Phone:636-282-0125
Mailing Address - Fax:
Practice Address - Street 1:4 ARNOLD MALL
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-2223
Practice Address - Country:US
Practice Address - Phone:636-282-0125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-08
Last Update Date:2010-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004032032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist